Original Article
Importance of monitoring zones in the detection of arrhythmias in patients with implantable cardioverter-defibrillators under remote monitoring
Importância da zona de monitorização na deteção de arritmias em portadores de cardioversor desfibrilhador implantável em programa de monitorização remota
Sílvia Aguiar Rosa
, Pedro Silva Cunha, Ana Lousinha, Bruno Valente, Ana Sofia Delgado, Ricardo Pimenta, Manuel Brás, Madalena Coutinho Cruz, Guilherme Portugal, André Viveiros Monteiro, Mário Oliveira, Rui Cruz Ferreira
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Cardiology Department, Santa Marta Hospital, Lisbon, Portugal
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=> true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Importance of monitoring zones in the detection of arrhythmias in patients with implantable cardioverter-defibrillators under remote monitoring" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "11" "paginaFinal" => "16" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Sílvia Aguiar Rosa, Pedro Silva Cunha, Ana Lousinha, Bruno Valente, Ana Sofia Delgado, Ricardo Pimenta, Manuel Brás, Madalena Coutinho Cruz, Guilherme Portugal, André Viveiros Monteiro, Mário Oliveira, Rui Cruz Ferreira" "autores" => array:12 [ 0 => array:4 [ "nombre" => "Sílvia" "apellidos" => "Aguiar Rosa" "email" => array:1 [ 0 => "silviaguiarosa@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Pedro" "apellidos" => "Silva Cunha" ] 2 => array:2 [ "nombre" => "Ana" "apellidos" => "Lousinha" ] 3 => array:2 [ "nombre" => "Bruno" "apellidos" => "Valente" ] 4 => array:2 [ "nombre" => "Ana Sofia" "apellidos" => "Delgado" ] 5 => array:2 [ "nombre" => "Ricardo" "apellidos" => "Pimenta" ] 6 => array:2 [ "nombre" => "Manuel" "apellidos" => "Brás" ] 7 => array:2 [ "nombre" => "Madalena" "apellidos" => "Coutinho Cruz" ] 8 => array:2 [ "nombre" => "Guilherme" "apellidos" => "Portugal" ] 9 => array:2 [ "nombre" => "André" "apellidos" => "Viveiros Monteiro" ] 10 => array:2 [ "nombre" => "Mário" "apellidos" => "Oliveira" ] 11 => array:2 [ "nombre" => "Rui" "apellidos" => "Cruz Ferreira" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Cardiology Department, Santa Marta Hospital, Lisbon, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Importância da zona de monitorização na deteção de arritmias em portadores de cardioversor desfibrilhador implantável em programa de monitorização remota" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1015 "Ancho" => 2091 "Tamanyo" => 60768 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Comparison of appropriate device therapies between patients with and without arrhythmic events detected in the monitoring zone.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Implantable cardioverter-defibrillators (ICDs) are the treatment of choice for primary prevention against sudden cardiac death.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">1</span></a> Arrhythmia therapy is delivered in the form of antitachycardia pacing (ATP) or shock. An ICD is able to terminate potentially life-threatening ventricular arrhythmias, preventing syncope, hypotension and, most importantly, sudden cardiac death. Device algorithms and thresholds for detection and therapies are programmed according to age, indication and the underlying cardiac disease.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">For lower heart rates, monitoring zones (MZ), in which the device does not deliver therapy but monitors the heart rhythm, are commonly used in clinical practice. MZ provide passive features that do not interfere with the functioning of active treatment zones. MZ can also classify events as supraventricular or ventricular arrhythmias.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">3</span></a> However, it is not known for certain whether the programming of an MZ affects arrhythmia detection by the ICD or the clinical management of these patients.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of the present study is to assess the benefit in clinical practice of MZ for treatment in a population of patients with ICDs or cardiac resynchronization therapy-defibrillator (CRT-D) devices for primary prevention.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">This was a retrospective analysis of patients implanted with an ICD or CRT-D for primary prevention at a tertiary center between 2006 and 2015. Devices were implanted according to international guidelines.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">4</span></a> Patients with indication for implantation for secondary prevention were excluded.</p><p id="par0025" class="elsevierStylePara elsevierViewall">All patients with a programmed MZ were considered for the study. This zone was programmed according to heart rate (140-170 bpm) and persistence (number of consecutive cycles >50). Therapy zones were programmed for 170-200 bpm for 30 out of 40 cycles (ATP attempts or shock), and >200 bpm for 12 out of 18 cycles (ATP during charge or shock).</p><p id="par0030" class="elsevierStylePara elsevierViewall">The MZ criteria were changed according to the arrhythmia data obtained via the device during follow-up. ATP-based therapy was activated only in patients presenting with slow VT (below the cut-off of 170 bpm).</p><p id="par0035" class="elsevierStylePara elsevierViewall">All enrolled patients received a remote monitoring (RM) system. The RM equipment was provided at the first outpatient visit after ICD or CRT-D implantation and reports were reviewed by trained staff under the supervision of a senior electrophysiologist.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Initially a retrospective analysis was performed of MZ reports through the RM system and recorded arrhythmias were assessed in detail. In patients with single-chamber devices, atrial fibrillation (AF) detection was based on heart rate combined with absence of stability criteria, according to cycle length irregularity during the arrhythmia. Sinus tachycardia, supraventricular tachycardia and non-sustained ventricular tachycardia (NSVT) were differentiated by the onset criteria and using comparison with native QRS complex morphology and cycle length. In patients with arrhythmic events documented in the MZ, the decision of the physician at the outpatient clinic visit regarding the treatment approach was analyzed by reviewing patient files. A second analysis of MZ reports through RM systems was then performed to determine the impact of changes in medication or invasive strategy on the recurrence of arrhythmic events. For all patients, data were collected regarding arrhythmic events, device programming and appropriate and inappropriate therapies via ICD or CRT-D.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">The statistical analysis was performed using IBM SPSS Statistics, version 19 (IBM SPSS, Chicago, IL). Continuous variables were expressed as mean ± standard deviation and categorical variables were expressed as percentage. Study groups were compared using the Student's t test or the Wilcoxon-Mann-Whitney test for continuous variables, and Pearson's chi-square or Fisher's exact test for categorical measures, as appropriate. A p-value <0.05 was considered statistically significant.</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">During the study period, 898 patients underwent ICD and CRT-D implantation, of whom 221 received the device for primary prevention with facilities for RM. The baseline characteristics of the study population are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Of the overall population, 77% were men, mean age was 64±12 years, and mean left ventricular ejection fraction was 30±12%. Dilated and ischemic cardiomyopathy were the most common underlying conditions, followed by hypertrophic cardiomyopathy, primary electrical cardiac disease and congenital heart disease.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Mean follow-up after implantation was 63±35 months, during which MZ data were collected. One hundred and seventy-four events were documented in the MZ in 139 patients (62.9% of the overall population) (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>). Supraventricular arrhythmias accounted for almost half of all findings (49.4%), with a similar incidence of supraventricular tachycardia and AF/atrial flutter. In 29 patients (20.9%), AF and other supraventricular arrhythmias were diagnosed based on electrograms from single-chamber ICDs. NSVT occurred in 74 patients (42.5% of all events) in the MZ. Only five events were due to noise. Regarding ICD therapy delivery, of the 137 patients who presented arrhythmic events in the MZ (excluding two patients with noise detection only), 22 (16.1%) received appropriate shocks and/or ATP, while in the other 84 patients without events in the MZ, 15.5% received appropriate ICD therapies (p=0.908) (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>). In patients with NSVT in the MZ the frequency of appropriate ICD therapy was not significantly different from the others, with 15 patients (20.5%) receiving device therapy.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">In accordance with the MZ findings, physicians decided to change outpatient medication in 58 patients (41.7% of all patients in whom arrhythmic events were reported in the MZ), due to supraventricular arrhythmia in 24 cases and to ventricular tachycardia in 34. In the presence of NSVT in the MZ, the initiation or titration of antiarrhythmic drugs (mainly beta-blockers and amiodarone) was based on the presence of symptoms and/or NSVT length and burden. Among these 58 subjects, six started beta-blockers, 11 started amiodarone, and eight (13.8%) started chronic oral anticoagulation. The previously prescribed antiarrhythmic drug dosage was titrated in 44 patients. Beta-blocker dosage was increased in 41 patients and amiodarone/sotalol dosage was increased in three cases. In addition to optimization of medical treatment, two patients underwent ablation of supraventricular arrhythmias detected in the MZ (atrial flutter and atrioventricular nodal reentrant tachycardia) and three underwent atrioventricular junction ablation due to AF with rapid ventricular response (and low percentage of biventricular pacing). Furthermore, internal cardioversion via the ICD was performed in one patient with persistent AF (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>). Since there was uncertainty whether the AF burden justified oral anticoagulation, the initiation of this medication was based on the physician's decision. However, in view of the high risk in this population, patients presenting AF episodes lasting >5 min were prescribed anticoagulation therapy.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">After optimization of medical therapy, 37 patients (63.8%) did not have recurrence of arrhythmic events in the MZ, 70.8% in the supraventricular arrhythmia subgroup and 55.6% in the ventricular tachycardia subgroup. In those with recurrence, 16 individuals presented NSVT episodes, five showed supraventricular tachycardia and two had paroxysmal AF. In three cases there was more than one type of arrhythmia. Despite changes in medication, 15 patients (25.9%) had recurrence of the same arrhythmia.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Among the 65 patients with NSVT, in whom antiarrhythmic medication was increased, during a follow-up of 10.0±7.5 months no appropriate therapies were delivered by the device, and more than half (55.6%) did not present recurrence of documented arrhythmias in the MZ. In the overall population, arrhythmic events in the MZ were detected in 62.9%, which led to treatment changes in 27.1%, with a consequent 17% decrease in the arrhythmic events detected in the MZ. There were no clinical or technical complications reported in relation to the activation of MZ.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">Programming an MZ for primary prevention in ICD patients leads to the detection of symptomatic or asymptomatic arrhythmias, indicating that it may be a useful tool in the optimization of medical and interventional treatment in this population.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The benefits of RM in preventing hospital admission for heart failure or cardiovascular death are well documented.<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">5–7</span></a> However, its usefulness in optimization of antiarrhythmic treatment has not been so extensively studied. As highlighted in the present study, RM enables early detection of new-onset or paroxysmal arrhythmias in the MZ and hence early therapeutic intervention.</p><p id="par0085" class="elsevierStylePara elsevierViewall">In our sample, arrhythmic events were documented in the MZ in 62.9% of patients. These findings had a significant impact on clinical practice, since in half of the patients outpatient medication was changed and/or ablation was performed. This optimization in patient management resulted in a considerable reduction in arrhythmic events reported in the MZ.</p><p id="par0090" class="elsevierStylePara elsevierViewall">As previously reported, patients with cardiac devices presented a high incidence of atrial arrhythmias, even in the absence of symptoms.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">8</span></a> Around 50% of ICD carriers can be expected to experience AF during the lifetime of the device.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">9</span></a> In our population, new-onset paroxysmal AF/atrial flutter was found in a significant proportion of patients (20%), leading to the initiation of oral anticoagulation. This incidence is similar to data reported by Ricci et al., who found an AF incidence of 26% in pacemaker/ICD patients.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">10</span></a> Since AF, even if paroxysmal or asymptomatic, is associated with a five-fold increase in the risk of ischemic stroke,<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">11</span></a> recognition of these episodes and initiation of anticoagulation may provide protection against thromboembolic events such as stroke. Programming an MZ provides valuable information on AF occurrence, AF burden and consequent stroke risk. These continuous monitoring data (particularly when combined with RM systems) can be of considerable value, since many AF episodes with clinically significant duration are asymptomatic.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">12</span></a> Improvements in use of and adherence to oral anticoagulation based on continuous ICD monitoring have recently been demonstrated.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">13</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">The impact of appropriate shocks on quality of life and morbidity in ICD patients remains a concern,<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">14–16</span></a> and reducing the rate of shock therapies is a real challenge for the ICD outpatient clinic. Initiation or titration of antiarrhythmic drugs in patients with NSVT documented in the MZ has the potential to reduce the rate of shocks and ATP delivered to patients. In fact, in our population, among patients with NSVT whose antiarrhythmic medication was optimized no shocks or ATP were delivered via the device, and 55.6% of these patients did not present recurrence of documented arrhythmias in the MZ. Since NSVT is associated with an increased risk of death in both ischemic<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">16</span></a> and non-ischemic cardiomyopathy,<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">17–19</span></a> its detection and consequent therapeutic optimization can potentially reduce ICD therapies in these patients.</p><p id="par0100" class="elsevierStylePara elsevierViewall">It is also important to emphasize that in our study, regardless of the type of arrhythmia recorded, analysis of the MZ had the potential to change physicians’ decisions in 27.1% of cases, with an impact on arrhythmia recurrence.</p><p id="par0105" class="elsevierStylePara elsevierViewall">There have been concerns that MZ can be associated with increased risk of inappropriate device therapy,<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">20,21</span></a> however in our study only two patients (0.9%) received inappropriate therapies due to AF with rapid ventricular response. This incidence is much lower than that described in the Detect Supraventricular Tachycardia Study, in which the rate of inappropriate detection of supraventricular tachycardias was 31%,<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">22</span></a> or in a study by van Rees et al. of a prospective registry, with 13% of inappropriate shocks.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">23</span></a> High-rate cut-off programming for detection and therapy in primary prevention has been shown to decrease this rate substantially to 6.6%.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">24</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The present study showed that continuous rhythm monitoring by the cardiac device unmasks arrhythmias in asymptomatic and symptomatic patients, with an impact on clinical management, leading to a significant decrease in arrhythmic events detected in the MZ.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Study limitations</span><p id="par0115" class="elsevierStylePara elsevierViewall">This is an observational long-term retrospective study with the inherent limitations, including the absence of a control group. The relatively small sample size results from the single-center nature of the study. However, our results reflect a real-life long-term clinical practice experience based on an RM program.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusion</span><p id="par0120" class="elsevierStylePara elsevierViewall">Detection of spontaneous ventricular and supraventricular arrhythmias are common findings in a population with implantable cardiac devices for primary prevention with a programmed MZ. The MZ appears to be of value in the diagnosis of arrhythmias, and may be a useful tool in clinical practice. In our study, the treatment approach was changed in about half of the patients based on MZ reports. It is also important to emphasize that anticoagulation was started in patients with previously unknown paroxysmal AF, providing an important measure in stroke prevention.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicts of interest</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1269327" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1174843" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1269328" "titulo" => "Resumo" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introdução" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1174842" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Study limitations" ] 9 => array:2 [ "identificador" => "sec0035" "titulo" => "Conclusion" ] 10 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-09-05" "fechaAceptado" => "2018-05-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1174843" "palabras" => array:5 [ 0 => "Implantable cardioverter-defibrillator" 1 => "Monitoring zone" 2 => "Supraventricular arrhythmias" 3 => "Ventricular arrhythmias" 4 => "Clinical practice" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec1174842" "palabras" => array:5 [ 0 => "Cardioversor desfibrilhador implantável" 1 => "Zona de monitorização" 2 => "Arritmias supraventriculares" 3 => "Arritmias ventriculares" 4 => "Prática clínica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Implantable cardioverter-defibrillator (ICD) monitoring zones (MZ) provide passive features that do not interfere with the functioning of active treatment zones. However, it is not known for certain whether programming an MZ affects arrhythmia detection by the ICD. The aim of the present study is to assess the clinical relevance of MZ in a population of patients with ICDs.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">In this retrospective analysis of patients with ICDs, with or without cardiac resynchronization therapy, for primary prevention under remote monitoring, the MZ was analyzed and recorded arrhythmias were assessed in detail.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 221 patients were studied (77% men; age 64±12 years). Mean ejection fraction was 30±12%. The mean follow-up was 63±35 months. One hundred and seventy-four MZ events were documented in 139 patients (62.9%): 74 of non-sustained ventricular tachycardia (NSVT), 42 of supraventricular tachycardia, 44 of atrial fibrillation/atrial flutter, and five cases of noise. Among the 137 patients who presented with arrhythmias in the MZ (excluding two cases with noise detection only), 22 (16.1%) received appropriate shocks and/or antitachycardia pacing (ATP), while of the other 84 patients, 15.5% received appropriate ICD treatment (p=NS). In patients who presented with NSVT in the MZ, 15 (20.5%) received appropriate shocks and/or ATP. In accordance with the MZ findings, physicians decided to change outpatient medication in 41.7% of all patients in whom arrhythmic events were reported.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Ventricular and supraventricular arrhythmias are common findings in the MZ of ICD patients. Programming an MZ is valuable in the diagnosis of arrhythmias and may be a useful tool in clinical practice.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introdução</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A zona de monitorização (ZM) de cardioversor desfibrilhador implantável (CDI) permite uma funcionalidade passiva que não interfere com o funcionamento das zonas de tratamento ativo. Contudo, não é perfeitamente conhecido se a programação de ZM afeta a deteção de arritmias pelo CDI. O objetivo do presente estudo é avaliar a relevância clínica de ZM numa população submetida a implantação de CDI.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Análise retrospetiva de doentes submetidos a implantação de CDI, com ou sem terapia de ressincronização cardíaca, em prevenção primária, sob monitorização remota. ZM foi analisada e as arritmias documentadas avaliadas em detalhe.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Foram estudados 221 doentes (77% homens; 64±12 anos). Fração de ejeção média foi 30±12%. O período de seguimento médio foi 63±35 meses. Foram documentados 174 eventos na ZM, em 139 doentes (62.9%): taquicardia ventricular não sustentada (TVNS) – 74, taquicardia supraventricular – 42, fibrilhação/flutter auricular – 44, ruído – 5. Dos 137 doentes que apresentaram arritmia na ZM (excluindo dois casos de deteção de ruído), 22 (16,1%) receberam choques apropriados ou <span class="elsevierStyleItalic">pacing</span> antitaquicardia (PAT), enquanto que dos restantes 84 doentes, 15,5% receberam terapias apropriadas do CDI (p=NS). Dos doentes que apresentaram TVNS na ZM, 15 (20,5%) receberam choques apropriados e/ou <span class="elsevierStyleItalic">pacing</span> anti-taquicardia (PAT). De acordo com os achados em ZM, o médico decidiu alterar a terapia oral de ambulatório em 41,7% de todos os doentes com eventos arrítmicos reportados.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusão</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Arritmas ventriculares e supraventriculares são achados comuns na ZM de CDI. A programação de ZM é importante no diagnóstico de arritmias e poderá ser um elemento útil na prática clínica.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introdução" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 803 "Ancho" => 2500 "Tamanyo" => 86472 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Arrhythmic events documented in the monitoring zone during follow-up.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1015 "Ancho" => 2091 "Tamanyo" => 60768 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Comparison of appropriate device therapies between patients with and without arrhythmic events detected in the monitoring zone.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 957 "Ancho" => 1574 "Tamanyo" => 70914 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Influence of monitoring zone reports on the treatment approach.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">CHD: congenital heart disease; CRT-D: cardiac resynchronization therapy-defibrillator; DCM: dilated cardiomyopathy; HCM: hypertrophic cardiomyopathy; ICD: implantable cardioverter-defibrillator; ICM: ischemic cardiomyopathy; LVEF: left ventricular ejection fraction; MZ: monitoring zone; VHD: valvular heart disease.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Overall population (n=221) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Events in MZ (n=139) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No events in MZ (n=82) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Age, years</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64±12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64.7±12.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63.0±15.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.364 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Male, n (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">170 (76.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">103 (74.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67 (81.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.120 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">LVEF, %</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30±12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.6±11.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33.5±12.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Etiology, n (%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">DCM</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95 (43.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75 (54.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 (24.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.007 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">ICM</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">94 (42.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50 (36.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 (53.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.027 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">HCM</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 (6.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (5.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (9.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.237 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Primary electrical cardiac disease</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (5.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (2.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (9.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.077 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">CHD</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (1.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (2.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (1.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.300 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">VHD</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (0.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (0.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (1.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Device, n (%)</span></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">ICD</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">138 (62.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73 (52.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65 (79.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Single-chamber \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">124 (89.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65 (47.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59 (42.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Dual-chamber \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 (10.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (5.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (4.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">CRT-D</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83 (37.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66 (47.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 (20.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Device programming, n (%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">MZ 140 bpm/VT 170 bpm/VF 210 bpm</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">171 (77.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">94 (67.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">77 (93.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">MZ 140 bpm/VT 170 bpm/VF 214 bpm</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50 (22.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45 (32.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (6.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2171171.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Baseline characteristics of the study population.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:24 [ 0 => array:3 [ "identificador" => "bib0125" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: the Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). 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| Ano/Mês | Html | Total | |
|---|---|---|---|
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| 2024 Junho | 46 | 24 | 70 |
| 2024 Maio | 68 | 25 | 93 |
| 2024 Abril | 43 | 27 | 70 |
| 2024 Maro | 44 | 22 | 66 |
| 2024 Fevereiro | 37 | 18 | 55 |
| 2024 Janeiro | 30 | 28 | 58 |
| 2023 Dezembro | 36 | 17 | 53 |
| 2023 Novembro | 54 | 39 | 93 |
| 2023 Outubro | 28 | 16 | 44 |
| 2023 Setembro | 33 | 18 | 51 |
| 2023 Agosto | 41 | 21 | 62 |
| 2023 Julho | 27 | 12 | 39 |
| 2023 Junho | 28 | 21 | 49 |
| 2023 Maio | 53 | 22 | 75 |
| 2023 Abril | 33 | 9 | 42 |
| 2023 Maro | 60 | 21 | 81 |
| 2023 Fevereiro | 49 | 19 | 68 |
| 2023 Janeiro | 21 | 13 | 34 |
| 2022 Dezembro | 50 | 22 | 72 |
| 2022 Novembro | 54 | 27 | 81 |
| 2022 Outubro | 67 | 28 | 95 |
| 2022 Setembro | 46 | 45 | 91 |
| 2022 Agosto | 34 | 38 | 72 |
| 2022 Julho | 45 | 34 | 79 |
| 2022 Junho | 31 | 32 | 63 |
| 2022 Maio | 37 | 36 | 73 |
| 2022 Abril | 37 | 31 | 68 |
| 2022 Maro | 60 | 44 | 104 |
| 2022 Fevereiro | 39 | 28 | 67 |
| 2022 Janeiro | 36 | 31 | 67 |
| 2021 Dezembro | 40 | 32 | 72 |
| 2021 Novembro | 40 | 52 | 92 |
| 2021 Outubro | 35 | 45 | 80 |
| 2021 Setembro | 23 | 26 | 49 |
| 2021 Agosto | 29 | 31 | 60 |
| 2021 Julho | 14 | 19 | 33 |
| 2021 Junho | 20 | 24 | 44 |
| 2021 Maio | 35 | 35 | 70 |
| 2021 Abril | 33 | 29 | 62 |
| 2021 Maro | 32 | 22 | 54 |
| 2021 Fevereiro | 37 | 17 | 54 |
| 2021 Janeiro | 31 | 14 | 45 |
| 2020 Dezembro | 27 | 12 | 39 |
| 2020 Novembro | 31 | 25 | 56 |
| 2020 Outubro | 40 | 11 | 51 |
| 2020 Setembro | 38 | 15 | 53 |
| 2020 Agosto | 28 | 7 | 35 |
| 2020 Julho | 18 | 13 | 31 |
| 2020 Junho | 33 | 10 | 43 |
| 2020 Maio | 19 | 12 | 31 |
| 2020 Abril | 32 | 12 | 44 |
| 2020 Maro | 29 | 16 | 45 |
| 2020 Fevereiro | 72 | 60 | 132 |
| 2020 Janeiro | 29 | 12 | 41 |
| 2019 Dezembro | 40 | 15 | 55 |
| 2019 Novembro | 31 | 6 | 37 |
| 2019 Outubro | 45 | 9 | 54 |
| 2019 Setembro | 31 | 18 | 49 |
| 2019 Agosto | 22 | 7 | 29 |
| 2019 Julho | 24 | 12 | 36 |
| 2019 Junho | 35 | 27 | 62 |
| 2019 Maio | 53 | 12 | 65 |
| 2019 Abril | 50 | 21 | 71 |
| 2019 Maro | 64 | 37 | 101 |
| 2019 Fevereiro | 49 | 38 | 87 |
| 2019 Janeiro | 7 | 8 | 15 |
Mostrar tudo
